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错误的思维框架
The Wrong Frame of Mind


Joseph A. McBride ... 其他 • 2018.05.03
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• 头孢他啶加阿维巴坦(avibactam):TB新疗法 • 病例10-2018:一名患无痛性单侧睾丸肿胀的84岁男性

本刊的这一栏目中,某真实患者的信息按阶段(粗体)呈现给一名临床专家,后者对这些信息做出回应并和读者分享其推理(普通字体)。作者随后做出评论。

 

一名患高血压和抑郁症的62岁女性到泌尿科门诊就诊,自诉有15个月的偶发排尿困难、血尿和多尿。并且有耻骨上不适,但无胁腹痛、恶心或早饱。她自诉无发热、寒战、盗汗、体重减轻、食欲减退、呼吸困难或咳嗽的症状。因症状困扰她已经到5名医务人员处就诊。所有尿样分析均显示白细胞酯酶+++,不含亚硝酸盐,每个高倍视野有10个以上白细胞和150个以上红细胞。患者每次就诊时均接受了尿路感染的经验性治疗。两次开具了甲氧苄啶-磺胺甲噁唑治疗,三次开具了环丙沙星治疗,但其症状没有减轻。所有的尿培养结果均为阴性。她没有性传播感染、腹部手术、肾结石或尿路感染史。她是一名家庭主妇,与她的儿子住在一起。她既往没有饮酒、吸烟使用违禁药品。她性行为不活跃。





作者信息

Joseph A. McBride, M.D., Alexander J. Lepak, M.D., Gurpreet Dhaliwal, M.D., Sanjay Saint, M.D., M.P.H., and Nasia Safdar, M.D., Ph.D.
From the William S. Middleton Memorial Veterans Hospital and the Department of Medicine (J.A.M., A.J.L., N.S.) and Department of Pediatrics (J.A.M.), University of Wisconsin–Madison School of Medicine, Madison; the Department of Internal Medicine, University of Michigan Medical School, and the Department of Veterans Affairs (VA) Health Services Research and Development Center of Excellence — both in Ann Arbor (S.S.); and the Medical Service, San Francisco VA Medical Center, and the Department of Medicine, University of California, San Francisco — both in San Francisco (G.D.). Address reprint requests to Dr. McBride at the Division of Infectious Diseases, University of Wisconsin–Madison, 1685 Highland Ave., Madison, WI 53705, or at jmcbride@medicine.wisc.edu.

 

参考文献

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